| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $367.50 | $367.50 | $8,500.00 | |
Aetna
| Professional | $367.50 | $367.50 | $367.50 | |
Cigna
| Professional | $464.05 | $751.53 | $970.49 | |
Medica
| Facility | $367.50 | $367.50 | $1,102.50 |